Provider Demographics
NPI:1427128636
Name:JAMES R SHELL
Entity type:Organization
Organization Name:JAMES R SHELL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHELL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:870-423-2737
Mailing Address - Street 1:408 PUBLIC SQ
Mailing Address - Street 2:
Mailing Address - City:BERRYVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72616-3958
Mailing Address - Country:US
Mailing Address - Phone:870-423-2737
Mailing Address - Fax:870-423-7253
Practice Address - Street 1:408 PUBLIC SQ
Practice Address - Street 2:
Practice Address - City:BERRYVILLE
Practice Address - State:AR
Practice Address - Zip Code:72616-3958
Practice Address - Country:US
Practice Address - Phone:870-423-2737
Practice Address - Fax:870-423-7253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR01783183500000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR100064407Medicaid
AR100064407Medicaid